Randy, and all.. I hate shoes. The rant begins.
Shoes are a huge waste of time. We take a college educated person
trained in human gait and pathological conditions of the foot who
designs devices for which a wheelchair bound individual can donn and
walk out the door. We turn said college educated person into a shoe
salesman to burn up at least 30 minutes assisting patients in picking
out shoe styles from a catalog, all for zero return. So lets say the
practitioner makes an earth shattering 15 dollars per hour( I picked low
on purpose). This sale has now burned up $7.50.
Then the front office staff(7.50/hr, again perhaps low) spent another 15
minutes(or $1.90) on the phone checking insurance coverage then orders
the shoes. What can we do? It must be done. No one else but O&P
offices provide extra or super depth shoes per doctors RX. For diabetics
I like to choose P.W. Minor “Thermolds” to protect their feet. I
believe they cost about $82.00 a pair. Shipping is approx. $8.00. Oh,
yes, the single order penalty is about $6.00. Total cost to buy the
shoe is $96.00. Factor in the hourly wages and the business has spent
$105.38 up front.
Then the fitting. Another 30 minutes, trim the inserts and when all is
said and done the cost is $112.88/pair. I love it when a plan comes
together. Medicare allowable is about $150 but they only pay 80% so that
is $120. Less than 5% of our patients are straight Medicare. HMOs may
have different and lower contracted fee schedule so prices may vary.What
we have here is a maximum $7.12 profit at best for one hour and 15
minutes of office time. What is wrong with this picture? Okay, I’m
preaching to the choir.
The billing department sends off a bill that adds overhead to the cost.
So the final profit is a, like shooting fish in a barrel, $3.00 profit
for a slam dunk fitting. Now, if I have to order another size and get
hit for a restocking and another shipping fee then all that profit flies
out the door faster than you can say plastizote. We go negative. The
winners in this are the patient because they get the shoe, and the shoe
company because they don’t have to deal with the extensive paperwork.
Providing shoes can only be considered a community service. I hope
diabetic and or patients with foot deformities are listening so that
they understand the circumstances and not be so picky. All I ask is
lets get a shoe on you that fits the medical need, color and style be
dammed. The shoes are free. “No, we can’t stock shoes like Norstroms.
It’s out of my control.”
Ask any consumer if they believe the retailer is making money on a sale
and they will say, “Duh, of course or they would be out of business”. I
hope P.W. Minor is listening. I don’t know if P.W. Minor shoes are the
best approach but we order a lot of them(99.9% of the time). We order
what the patient needs. A week or so later comes the fitting. If it is
not right I try again. And fitting is a big issue. I even bought
P.W.Minor’s own special Ritz stick made for their lasts and still that
did not solve the fitting issue. Wide forefeet and narrow heels drive
me crazy. Add to that plastizote inserts that provide some springiness
and you get a shoe that has an increased chance to move up and down in
the heel. Patients don’t like that for some reason. PW Minor charges
single order fees(patients don’t want to wait until we get enough orders
to make it worth our while). Single order and restocking fees may not
be exclusive to PW Minor. They charge shipping fees, they charge
restocking fees(even using their own Ritz sticks with Summit and Contour
last sizing can’t solve this), and it costs us to ship them back, they
don’t make Thermold styles( recommended for diabetics) with velcro
closures in all sizes (the diabetic patients are usually older and have
problems tying laces) and color selection is poor. But the deerskin is
nice.
Hey, I know, I’ll tear out most of shoe styles from the catalog limiting
selection to just a few styles. Wow, that should do it.
She wants Dutchess TM Perf (gets sweaty and wants air ventilation)in
Clay(goes with most of her clothes) with velcro(has trouble with laces)
and measures 6M(B).
Joe: “It only comes in laces. But I can convert it to velcro. It will
not look like a factory velcro closure but it is velcro. I’ll order it
and we will call you in a week or so.”
One week later, maybe. Now for the fitting. It fits the forefoot but the
heel slides on the right foot.
Patient: “I need a shoe that doesn’t slide in the heel. And sometimes I
wear thinner socks on hotter days.
Joe: “Problem, you can’t get this style in 6M(A), the next width
narrower is 2A. Besides it may well be too tight in the forefoot.
Thicker socks will make matters worse. How about a Lady Pillow Back,
it’s a perf and it comes in 6A with velcro. Still may be tight”
Patient: ” In clay?”
Joe: How about Buckskin, it doesn’t come in clay!
Patient: Will it fit my heel?
Joe: “Let’s try.”
Patient:” When?”
Joe: “In about one week or so. It has to be ordered.”
Patient: With disgusted look on face. “If I have to. I really want clay
though. Why don’t you carry enough shoes for people like me?”
Joe: “Please pick off the menu. No substitutions.”
Can I go work on a KAFO now?
Does this sound familiar? All help is appreciated.
Joe Harvey NCOPE resident
